Holy Angel University

College of Nursing

Enucleation of
The Globe

Submitted by:

Rennel D. Escoto
Definition

Enucleation is the surgical removal of the eyeball that leaves the eye muscles and remaining
orbital contents intact.

Enucleation is performed to remove large-sized eye tumors or as a result of traumatic injury

when the eye cannot be preserved. In the case of tumors, the amount of radiation required to
destroy a tumor of the eye may be too intense for the eye to bear. Within months to years, many
patients who are treated with radiation for large ocular melanomas lose vision, develop
glaucoma, and eventually have to undergo enucleation.

The two types of eye tumors that may require enucleation are:

 Intraocular eye melanoma. This is a rare form of cancer in which malignant cells are
found in the part of the eye called the uvea, which contains cells called melanocytes that
house pigments. When the melanocytes become cancerous, the cancer is called a
melanoma. If the tumor reaches the iris and begins to grow, or if there are symptoms,
enucleation may be indicated.
 Retinoblastoma. Retinoblastoma is a malignant tumor of the retina. The retina is the thin
layer of tissue that lines the back of the eye; it senses light and forms images. If the
cancer occurs in one eye, treatment may consist of enucleation for large tumors when
there is no expectation that useful vision can be preserved. If there is cancer in both eyes,
treatment may involve enucleation of the eye with the larger tumor, and radiation therapy
for the other eye.

The conjunctiva (outer covering of eye) is removed with blunt scissors (A). The four
rectus muscles are removed from their attachments to the eyeball (B). The optic nerve is
severed (C), and the eyeball is removed. A synthetic globe replaces the eyeball in the
socket, and the rectus muscles are sutured around it (D).
Description
Following anesthesia, the surgeon measures the dimensions of the eye globe, length of the optic
nerve, and horizontal dimensions of the cornea. The surgeon then illuminates the globe of the
eye before opening it. A dissecting microscope is used to detect major features and possible
minute lesions. The eye is opened with a sharp razor blade by holding the globe with the left
hand, cornea down against the cutting block, and holding the blade between the thumb and
middle finger of the right hand. Enucleation proceeds with a sawing motion from back to front.
The plane of section begins adjacent to the optic nerve and ends at the periphery of the cornea.
The plane of section is dependent on whether a lesion has been detected. If not, the globe is cut
along a horizontal plane, using as surface landmarks the superior and inferior oblique insertions
and the long postciliary vein. If a lesion has been found, the plane of section is modified so that
the lesion is included in the slab.

Diagnosis/Preparation
Enucleation may be performed under general or local anesthesia. In either case, the
injection is given in the retrobulbar space. An antibiotic and an anti-inflammatory
medication such as dexamethasone are also given intravenously.

Aftercare
Because the eye is surrounded by bones, it is much easier for patients to tolerate
enucleation than the loss of a lung or kidney. When surgery is performed under general
anesthesia, patients do not feel or see anything until they regain consciousness. Additional local
anesthesia is often given at the end of the surgery so that the patient will have the least pain
possible when waking up in the recovery room . Most patients have a headache for 24–36 hours
after surgery that is relieved with two regular headache medication pills, such as Tylenol, every
four hours. A firm pressure dressing is maintained for four to six days, such oral antibiotics are
given for one week; and steroids, as prednisone, adjusted according to patient status, are given
three times daily for four days. The socket is evaluated after removal of the pressure dressing. If
the edema has disappeared, the sutures are removed. Topical antibiotics are applied four times
daily for four weeks.

Risks
Enucleation surgery is very safe; only rarely do patients experience major
complications. Complications include the following: bleeding, infection, scarring,
persistent swelling, pain, wound separation, and the need for additional surgery.
Complications may also occur with the orbital implants routinely used with patients
who have undergone enucleation. Among these is the risk of infection.
Normal results
Within two to six weeks of enucleation surgery, patients are sent for a temporary ocular
prosthesis (plastic eye). Besides the swelling and the black eye, patient features look normal.
After a final prosthetic fitting, 90% of patients are usually quite happy with the way they look;
80% say others cannot even tell that they have only one eye.

Alternatives
There are no alternatives to enucleation because it is a procedure of last resort
performed when other treatments have failed.